Kaiser Health News reports from the Associated Press, that big players in the health industry are seeing the cost benefits of nabbing problems before they start. That hot lunch delivered to your door? Your health insurer might pick up the tab. The cleaning crew that fixed up your apartment while you recovered from a stroke? The hospital staff helped set that up.

Some insurers are paying for rides to fitness centers and checking in with customers to help ward off loneliness. Hospital networks are hiring more workers to visit people at home and learn about their lives, not just their illnesses.

The health care system is becoming more focused on keeping patients healthy instead of waiting to treat them once they become sick or wind up in the hospital. This isn’t a new concept, but it’s growing. Insurers are expanding what they pay for to confront rising costs, realizing that a person’s health depends mostly on what happens outside a doctor’s visit.

According to Reuters, Dr. Atul Gawande, a surgeon who was named this week to head the company being formed by Amazon, Berkshire Hathaway and JPMorgan Chase to trim employee healthcare costs, cited surgery as the single biggest U.S. healthcare cost and said there are ways to both cut costs and improve patient care.

Gawande, 52, is a surgeon, writer and public health thought leader and practices general and endocrine surgery at Brigham and Women’s Hospital in Boston. He is also a professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School and founding executive director of the health systems innovation center, Ariadne Labs. Gawande also is a staff writer for The New Yorker magazine and author of four books on health care.

End-of-life care needs to take into account the wishes of patients, something which he said is now sorely lacking.

According to ABC news, OneCare Vermont covered about 24,000 Medicaid patients and now covers about 112,000 patients whose health care is provided through Medicare, Medicaid and commercial insurance.

The long-term goal is to expand it so that about 70 percent of health care services provided in Vermont are covered by the system, which encourages patients to stay healthier using specialized care, such as helping them manage chronic conditions like diabetes so they don't wind up needing more expensive treatment. Officials consider 70 percent a realistic goal.

In a switch from when providers were paid for each service performed, providers are allocated a set amount of money to cover the people in the program. This year, $580 million has been allocated to OneCare Vermont, an organization of health care providers tasked by the state with carrying out the spirit of the program.

In a January 2018 post in NEJM Catalyst by Onil Bhattacharyya, MD, PhD, David Blumenthal, MD, MPP & Eric C. Schneider, MD, MSc, authors note that innovating in clinical care redesign involves creating new products, services, or processes which is fraught with uncertainty.

The authors make the point that given the choice, most organizations are more comfortable with the predictability of quality improvement, labeling it innovation in some cases, but shunning the risk-taking that characterizes true innovation work.

The New York Times reports that Amazon, Berkshire Hathaway and JPMorgan Chase just announced they would form an independent health care company to serve their employees.

The three companies noted the new entity would initially focus on technology to provide simplified, high-quality health care for their employees and their families, and at a reasonable cost.

The partnership brings together three of the country’s most influential companies to try to improve a system that other companies have tried and failed to change: Amazon, the largest online retailer in the world; Berkshire Hathaway, the holding company led by the billionaire investor Warren E. Buffett; and JPMorgan Chase, the largest bank in the United States by assets.

According to David Blumenthal of the Commonwealth Fund, Americans are dying younger which is a reflection of the failure of the American health system.

Blumenthal notes that while it is easy to blame the nation’s opioid epidemic, the abysmal new life expectancy data from the Centers for Disease Control and Prevention show the data for what they are — an indictment of the American health care system.

According to the CDC, the average life expectancy at birth in the U.S. fell by 0.1 years, to 78.6, in 2016, following a similar drop in 2015. This is the first time in 50 years that life expectancy has fallen for two years running. In 25 other developed countries, life expectancy in 2015 averaged 81.8 years.

In the annual Monitoring the Future study by the University of Michigan, now in its 43rd year, about 45,000 students in some 380 public and private secondary schools have been surveyed each year in this U.S. national study, designed and conducted by research scientists at the University of Michigan’s Institute for Social Research and funded by the National Institute on Drug Abuse. Students in grades 8, 10 and 12 are surveyed.

Highlights:

This increase in marijuana drove trends in any illicit drug use in the past year. Marijuana use among adolescents edged upward in 2017, the first significant increase in seven years. Overall, past-year use of marijuana significantly increased by 1.3% to 24% in 2017 for 8th, 10th, and 12th graders combined.

The 2017 survey also reports first-ever national, standard estimates of nicotine vaping, marijuana vaping, flavoring-only vaping, and any vaping. Previously, no national study has published estimates for vaping of specific substances for the standard time periods of past 30 days, past year, and lifetime.

Cigarette smoking by teens continued to decline in 2017. For the three grades combined, all measures (lifetime, 30-day, daily, and half-pack/day) are at historic lows since first measured in all three grades in 1991. Since the peak levels reached in the mid-1990s, lifetime prevalence has fallen by 71%, 30-day prevalence by 81%, daily prevalence by 86%, and current half-pack-a-day prevalence by 91%.

Smokeless tobacco also showed a continuing decline this year with 30-day prevalence reaching a low point for the three grades individually and combined.

In general, alcohol use by adolescents has been in a long-term decline that actually first began in the 1980s and was interrupted for a few years during the relapse phase in the substance use epidemic in the 1990s.

In 2017, however, lifetime prevalence, annual prevalence, 30-day prevalence, and daily prevalence all showed little or no change with no significant changes for any grade or for the three grades combined. This is the first time this has happened in many years and may herald the end of the long-term decline in adolescent alcohol use.

Use of inhalants significantly increased among 8th grade students in 2017. Inhalant use includes sniffing glue, gases, or sprays, and is an unusual type of substance use because it is more common among younger than older adolescents.

The opioid epidemic among adults has received much attention in recent months, and MTF offers the opportunity to see what is happening with opioid use among adolescents. Heroin use by adolescents has always been low, and did not significantly change in the 8th, 10th, or 12th grades in 2017, with annual use levels at 0.4% or lower in all three grades.

United Health Foundation's America’s Health Rankings annual report is out, one of the longest-running assessment of the nation’s health on a state-by-state basis.

According to the 2017 report, the analysis looks at 35 measures covering behaviors, community and environment, policy, clinical care and outcomes data. The report also serves as a benchmark for states – and the nation – to measure progress, identify emerging trends and drive action for improving public health.

The nation is facing public health challenges, including rising rates of premature death and an uneven concentration of key health care providers.

According to a report in StatNews, the Medicare Hospital Readmission Reduction Program has achieved its primary goal: It has reduced readmissions. A wide body of evidence shows that readmissions began to fall in 2012, when financial penalties took full effect. They have since declined several percentage points in each of the three conditions originally included in the program, according to a Kaiser Family Foundation analysis of Medicare data.

According to Kaiser Health News, Even though many hospitals are skeptical about the scientific soundness of ratings systems from organizations, such as The Leapfrog Group, such hospitals take their safety ratings seriously and have begun to take action to defend their performance and reputation.

The Leapfrog Group on Thursday released its 2017 Top Hospitals list, recognizing 109 hospitals for excellence in hospital quality, patient safety, and efficiency.

Leapfrog President and CEO Leah Binder in a release said, "The Top Hospital award highlights American hospitals that are providing the highest quality of care to their patients." She added, "We're encouraged to see hospitals across the country and within diverse communities earn this distinction."

In a recent article in the Health Affairs blog, the NYC Health + Hospitals ACO (NYCHH ACO) reduced costs by 4–12 percent annually compared to benchmark, while continually improving quality in its first four years. It is the only ACO in New York State to achieve shared savings in all four Medicare SSP performance years. Overall costs to Medicare have been reduced by more than $31 million, generating shared savings incentive payments of nearly $14 million.

In an article published November 9th on the Health Affairs Blog, Timothy Jost, Emeritus Professor at the Washington and Lee University School of Law and a member of the Institute of Medicine, cataloged the potential ramifications of what a Trump Presidency might mean for the Affordable Care Act. A summary of Jost's arguments are included below:

The Department of Health & Human Services (HHS) finalized a new payment system for Medicare clinicians that will continue to reform how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the Sustainable Growth Rate (SGR), is designed to consolidate the SGR, Meaningful Use, and the Value Modifier into a single alternative payment system. According to the HHS press release, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.

The US Government Accounting Office said in a report that the Department of Health and Human Services (HHS) should comprehensively plan and set timelines in developing more meaningful quality measures, and prioritize development of electronic quality measures. The Medicare Access and CHIP Reauthorization Act of 2015 called for GAO to examine the use of quality measures across HHS programs and private payers, with a focus on reducing burden. In the report, HHS concurs with the GAO recommendations.

Payment reform has become a dominant issue in Medicaid policy, reflecting a broader effort among all payers to reduce spending while improving outcomes. But Medicaid faces unique challenges, including a low-income population with disproportionately high health care needs, as well as surging enrollment in states that have implemented the Affordable Care Act’s Medicaid expansion. One of the goals of payment reform in Medicaid therefore is to use payment to stimulate health care innovation for medically underserved populations who depend on safety-net providers. To meet this challenge, several Medicaid expansion states are now beginning to adapt the special federal payment policies that apply to the nation’s nearly 1,400 community health centers.

For consumers the most visible change may be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years.

According to a national poll released Thursday survey by The John A. Hartford Foundation, the California Health Care Foundation and Cambia Health Foundation, doctors are having a difficult time starting end of life discussions and, when they do, aren't sure what to say.

Such discussions are becoming more important as baby boomers reach their golden years. By 2030, an estimated 72 million Americans will be 65 or over, nearly one-fifth of the U.S. population.